Automatic disinfection of a vascular access device connector

ABSTRACT

A device to couple a vascular access device to a medical device may include a body, a spring, and a housing. The body may include a distal end, a proximal end, and a lumen extending through the distal end and the proximal end. The proximal end of the body may include a connector. The housing may be coupled to a proximal end of the spring and may enclose the connector. A distal end of the spring may be coupled to the body. The housing may include a flap, which may include an antimicrobial compound. When the housing is disposed in a proximal position, the flap may cover the connector, the antimicrobial compound may contact the connector, and the spring may be uncompressed. In response to movement of the housing from the proximal position to a distal position, the spring may be compressed and the flap may open.

RELATED APPLICATIONS

This application is a divisional of U.S. Provisional patent applicationSer. No. 16/878,264, filed May 19, 2020, and entitled AUTOMATICDISINFECTION OF A VASCULAR ACCESS DEVICE CONNECTOR, which claims thebenefit of U.S. Provisional Patent Application No. 62/854,742, filed May30, 2019, and entitled AUTOMATIC DISINFECTION OF A VASCULAR ACCESSDEVICE CONNECTOR, which are incorporated herein in their entirety.

BACKGROUND

Intravenous catheters are commonly used for a variety of infusiontherapies. For example, intravenous catheters may be used for infusingfluids, such as normal saline solution, various medicaments, and totalparenteral nutrition, into a patient. Intravenous catheters may also beused for withdrawing blood from the patient.

Common types of intravenous catheter are peripheral IV catheters(“PIVCs”), peripherally inserted central catheters (“PICCs”), andmidline catheters. Intravenous catheters may include “over-the needle”catheters, which may be mounted over an introducer needle having a sharpdistal tip. The sharp distal tip may be used to pierce skin and thevasculature of the patient. Insertion of the intravenous catheter intothe vasculature may follow the piercing of the vasculature by theneedle. The needle and the intravenous catheter are generally insertedat a shallow angle through the skin into the vasculature of the patientwith a bevel of the needle facing away from the skin of the patient.Once placement of the needle within the vasculature has been confirmed,the clinician may temporarily occlude flow in the vasculature andwithdraw the needle, leaving the intravenous catheter in place forfuture blood withdrawal and/or fluid infusion.

A needleless connector may be used to connect the intravenous catheterwith a medical device for fluid administration or blood withdrawal. Themedical device may include a transfusion bag, syringe, or the like.Oftentimes, during infusion therapy, a proximal end of the needlelessconnector is left exposed to non-sterile surfaces. When the proximal endof the needleless connector is exposed, it may be contaminated by theclinician, the patient, bedding, a table, floor surfaces, or any numberof other contamination sources.

Exposed needleless connectors are potential sites for intraluminalmicrobial contamination, which may lead to catheter related blood streaminfection (“CRBSI”). CRBSIs are an important cause of illness and excessmedical costs, as approximately 250,000 CRBSIs occur in United Statesintensive care units each year. Despite guidelines to help reducehealthcare associated infections, CRBSIs continue to plague ourhealthcare system. Needleless connectors have been identified as asource of contamination to cause CRBSI during fluid administration.

Current standards recommend disinfection of needleless connectors via avigorous mechanical scrub and drying time prior to each use and suggestuse of passive disinfection caps. Adherence to needleless connectordisinfection protocols varies across clinicians and is furthercomplicated by different manufacturers requiring different length ofscrub and dry time, often resulting in incomplete disinfection of theneedleless connector and increasing a risk of bloodstream infection. Useof passive disinfection caps is not ubiquitous at this time, often dueto hospital policy, variability in clinician adherence to cap usageprotocol, and the increased clinician time to find and place thedisinfection caps.

The subject matter claimed herein is not limited to embodiments thatsolve any disadvantages or that operate only in environments such asthose described above. Rather, this background is only provided toillustrate one example technology area where some implementationsdescribed herein may be practiced.

SUMMARY

In some embodiments, a device to couple a vascular access device to amedical device may include a body, a spring, and a housing. In someembodiments, the body may include a distal end, a proximal end, and alumen extending through the distal end and the proximal end. In someembodiments, the proximal end of the body may include a connector, whichmay include a needleless connector or another connector. In someembodiments, the distal end of the body may include a luer connector oranother suitable connector coupled to a vascular access device.

In some embodiments, the housing may be coupled to a proximal end of thespring and may enclose the connector. In some embodiments, a distal endof the spring may be coupled to the body. In some embodiments, thehousing may include a flap, which may include an antimicrobial compound.In some embodiments, when the housing is disposed in a proximalposition, the flap may cover the connector, the antimicrobial compoundmay contact the connector, and the spring may be uncompressed. In someembodiments, in response to movement of the housing from the proximalposition to a distal position, the spring may be compressed and the flapmay open.

In some embodiments, the device may include a support structure, whichmay include one or more elongated guides. In some embodiments, thehousing may include one or more flanges. In some embodiments, inresponse to movement of the housing from the proximal position to thedistal position, the flanges may be configured to move along theelongated guides in a distal direction.

In some embodiments, the elongated guide may include one or more stops.In some embodiments, the flanges may be configured to move along theguides in the distal direction when the flanges are proximal to andspaced apart from the stops. In some embodiments, in response tomovement of the housing in the distal direction and the flangecontacting the stop, the housing and the support structure may beconfigured to move together in the distal direction.

In some embodiments, a proximal end of the support structure may includean opening. In some embodiments, a diameter of the opening may be lessthan a diameter of the flap, which may prevent the flap from fullyopening when the housing is disposed in the proximal position.

In some embodiments, a device to disinfect a vascular access deviceconnector may include an inner housing and an outer housing. In someembodiments, the inner housing may include a proximal opening and may beconfigured to receive the vascular access device connector. In someembodiments, the outer housing may be moveable with respect to the innerhousing between a proximal position and a distal position. In someembodiments, the outer housing may include a set of teeth.

In some embodiments, the device may include a rachet wheel, which mayinclude an inner set of teeth and an outer set of teeth. In someembodiments, a first mandrel may extend through the rachet wheel and mayinclude a pawl. In some embodiments, a second mandrel may be disposed onan opposite side of the inner housing as the first mandrel.

In some embodiments, antimicrobial strip may be wrapped around thesecond mandrel and coupled to the first mandrel. In some embodiments,the antimicrobial strip may extend over the proximal opening of theinner housing. In some embodiments, in response to movement of the outerhousing between the proximal position and the distal position, the pawlmay catch against the inner set of teeth, the set of teeth of the innersurface may successively engage the outer set of teeth, and the rachetwheel and the mandrel may rotate such that the antimicrobial strip movesacross the proximal opening of the inner housing.

In some embodiments, in response to movement of the outer housingbetween the proximal position and the distal position, the antimicrobialstrip may wrapped around the first mandrel and/or unwrapped from thesecond mandrel. In some embodiments, the antimicrobial strip may includemultiple holes configured to allow a medical device to couple to thevascular access device connector for infusion or blood withdrawal.

In some embodiments, the outer housing may include a flap. In someembodiments, in response to movement of the outer housing between theproximal position and the distal position, the flap may be opened. Insome embodiments, the outer housing may be configured to enclose thevascular access device connector.

In some embodiments, the device may include another rachet wheel. Insome embodiments, the first mandrel may extend through the other rachetwheel. In some embodiments, the antimicrobial strip may be disposedbetween the rachet wheel and the other rachet wheel. In someembodiments, the device may include an arm extending through themandrel. In some embodiments, the mandrel may be configured to rotatewith respect to the arm. In some embodiments, the arm may be coupled tothe inner housing.

The object and advantages of the embodiments will be realized andachieved at least by the elements, features, and combinationsparticularly pointed out in the claims. It is to be understood that boththe foregoing general description and the following detailed descriptionare exemplary and explanatory and are not restrictive of the invention,as claimed.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

Example embodiments will be described and explained with additionalspecificity and detail through the use of the accompanying drawings inwhich:

FIG. 1 is an upper perspective view of an example catheter system,according to some embodiments;

FIG. 2A is an upper perspective view of an example device to couple thecatheter system to a medical device, illustrating an example housing ofthe device disposed in a proximal position, according to someembodiments;

FIG. 2B is another upper perspective view of the device of FIG. 2A,illustrating the housing disposed in a first distal position, accordingto some embodiments;

FIG. 2C is another upper perspective view of the device of FIG. 2A,illustrating the housing disposed in a second distal position, accordingto some embodiments;

FIG. 3A is a cross-sectional view of the device of FIG. 2A, illustratingthe housing disposed in the proximal position and including an outerportion, according to some embodiments;

FIG. 3B is a cross-sectional view of the device of FIG. 2B, illustratingthe housing disposed in the first distal position, according to someembodiments;

FIG. 3C is a cross-sectional view of the device of FIG. 2C, illustratingthe housing disposed in the second distal position, according to someembodiments;

FIG. 4A is an exploded view of another example catheter system,according to some embodiments;

FIG. 4B is an upper perspective view of an example housing of thecatheter system of FIG. 4A, illustrating the housing in a closedposition, according to some embodiments;

FIG. 4C is another upper perspective view of the housing of FIG. 4B,illustrating the housing in an open position, according to someembodiments;

FIG. 4D is another upper perspective view of the housing of FIG. 4Bcoupled to an example needleless connector, according to someembodiments;

FIG. 4E is a bottom view of an example cover, according to someembodiments;

FIG. 5A is an exploded view of another example catheter system,according to some embodiments;

FIG. 5B is an upper perspective view of an example housing of thecatheter system of FIG. 5A, illustrating the housing in a closedposition, according to some embodiments;

FIG. 5C is another upper perspective view of the housing of FIG. 5B,illustrating the housing in an open position, according to someembodiments;

FIG. 5D is another upper perspective view of the housing of FIG. 5Bcoupled to an example needleless connector, according to someembodiments;

FIG. 5E is a proximal end view of the housing of FIG. 5B, according tosome embodiments;

FIG. 6A is an exploded view of another example catheter system,according to some embodiments;

FIG. 6B is an upper perspective view of an example housing of thecatheter system of FIG. 6A, illustrating the housing in a closedposition, according to some embodiments;

FIG. 6C is another upper perspective view of the housing of FIG. 6B,illustrating the housing in an open position, according to someembodiments;

FIG. 6D is another upper perspective view of the housing of FIG. 6Bcoupled to an example needleless connector, according to someembodiments;

FIG. 7A is an exploded view of another example catheter system,according to some embodiments;

FIG. 7B is an upper perspective view of an example housing of thecatheter system of FIG. 7A, illustrating the housing in an openposition, according to some embodiments;

FIG. 7C is another upper perspective view of the housing of FIG. 7B,illustrating the housing in a partially closed position, according tosome embodiments;

FIG. 7D is another upper perspective view of the housing of FIG. 7Bcoupled to an example needleless connector, according to someembodiments;

FIG. 8A is a partial cutaway view of an example device, illustrating anexample outer housing disposed in a proximal position, according to someembodiments;

FIG. 8B is another partial cutaway view of the device of FIG. 8A, theouter housing moved to a distal position, according to some embodiments;

FIG. 8C is another partial cutaway view of the device of FIG. 8A,illustrating the outer housing moved to back to the proximal position,according to some embodiments;

FIG. 8D is an upper perspective view of an example first mandrel of arachet mechanism of the device of FIG. 8A, according to someembodiments;

FIG. 8E is an upper perspective view of an example second mandrel of thedevice of FIG. 8A, according to some embodiments;

FIG. 8F is an upper perspective view of an example rachet wheel of FIG.8D, illustrating an example pawl in a loose position, according to someembodiments;

FIG. 8G is an upper perspective view of the rachet wheel of FIG. 8D,illustrating the in a catch position, according to some embodiments;

FIG. 9A is an upper perspective view of the device of FIG. 2A,illustrating the device in a retracted position, according to someembodiments;

FIG. 9B is an upper perspective view of the device of FIG. 2A,illustrating the housing and the body sliding axially toward each otherto move the device from the retracted position to a projected position,according to some embodiments;

FIG. 9C is an upper perspective view of the device of FIG. 2A,illustrating the device in the projected position, according to someembodiments;

FIG. 9D is a side view of the device of FIG. 2A, illustrating the devicein the projected position, according to some embodiments;

FIG. 9E is a cross-sectional view of the device of FIG. 2A, illustratingthe device in the projected position, according to some embodiments;

FIG. 9F is a cross-sectional view of the device of FIG. 2A, illustratingthe device in the retracted position, according to some embodiments;

FIG. 10A is an enlarged upper perspective view of a portion of thedevice of FIG. 2A, illustrating the housing and the body in a firstposition, according to some embodiments;

FIG. 10B is an enlarged upper perspective view of the portion of thedevice of FIG. 2A, illustrating the housing and the body in a secondposition, according to some embodiments;

FIG. 10C is an enlarged upper perspective view of the portion of thedevice of FIG. 2A, illustrating the device locked in the projectedposition;

FIG. 10D is an enlarged upper perspective view of the portion of thedevice of FIG. 2A, illustrating the housing and the body in a thirdposition, according to some embodiments;

FIG. 10E is an enlarged upper perspective view of the portion of thedevice of FIG. 2A, illustrating the housing and the body in a fourthposition, according to some embodiments;

FIG. 10F is an enlarged upper perspective view of the portion of thedevice of FIG. 2A, illustrating the housing and the body in a fifthposition, according to some embodiments; and

FIG. 10G is an enlarged upper perspective view of the portion of thedevice of FIG. 2A, illustrating the device in the retracted position,according to some embodiments.

DESCRIPTION OF EMBODIMENTS

Referring now to FIG. 1 , an example catheter system 14 is illustrated,according to some embodiments. In some embodiments, the catheter system14 may include a catheter assembly 16. In some embodiments, the catheterassembly 16 may include a catheter adapter 18 and a catheter 20extending distally from the catheter adapter 18. In some embodiments,the catheter adapter 18 may include a side port 22 in fluidcommunication with the lumen of the catheter adapter 18. In someembodiments, the catheter adapter 18 may include a proximal end 23, adistal end 24, and a lumen extending there between. In some embodiments,the catheter 20 may include a PIVC, a PICC, or a midline catheter.

In some embodiments, the catheter assembly 16 may be removably coupledto a needle assembly, which may include a needle hub 26 and anintroducer needle 28. In some embodiments, the introducer needle 28 mayinclude a sharp distal tip 30. In some embodiments, a proximal end ofthe introducer needle 28 may be secured within the needle hub 26. Insome embodiments, the introducer needle 28 may extend through thecatheter 20 when the catheter assembly 16 is in an insertion positionready for insertion into vasculature of a patient, as illustrated, forexample, in FIG. 1 . In some embodiments, in response to the introducerneedle 28 being inserted into the vasculature of the patient, flashbackof blood may flow through the sharp distal tip 30 of the introducerneedle 28 and may be visible to a clinician between the introducerneedle 28 and the catheter 20 and/or at another location within thecatheter assembly 16.

In some embodiments, in response to confirmation via the blood flashbackthat the catheter 20 is positioned within vasculature of the patient,the needle assembly may be removed from the catheter assembly 16. Insome embodiments, when the needle assembly is coupled to the catheterassembly 16, the introducer needle 28 of the needle assembly may extendthrough a septum disposed within the lumen of the catheter adapter 18.

In some embodiments, the catheter system 14 may include an extension set32, which may include an extension tube 34 and/or a clamp (notillustrated). In some embodiments, a distal end of the extension tube 34may be integrated with the catheter adapter 18. For example, theextension tube 34 may be integrated with the side port 22 of thecatheter adapter 18. In some embodiments, the extension tube 34 may beremovably coupled to the catheter adapter 18. In some embodiments, theclamp may selectively close off the extension tube 34 to prevent bloodor another fluid from flowing through the extension tube 34.

In some embodiments, the extension set 32 may include an adapter 38coupled to a proximal end of the extension tube 34. In some embodiments,the adapter 38 may include a Y-adapter or another suitable connector. Insome embodiments, a device 40 may be coupled to the adapter 38. In someembodiments, the device 40 may be used to connect the catheter system 14with a medical device for fluid administration or blood withdrawal. Insome embodiments, the medical device may include a transfusion bag,syringe, or any other suitable medical device. In some embodiments, thedevice 40 may be configured to prevent contamination of a connectorwithin the device 40, as will be explained in further detail.

In some embodiments, the device 40 may be used with the catheter system14 of FIG. 1 or any other suitable catheter system. In some embodiments,the catheter system 14 may be integrated, having an integrated extensiontube, such as, for example, the BD NEXIVA™ Closed IV Catheter System,the BD NEXIVA™ DIFFUSICS™ Closed IV Catheter System, the BD PEGASUS™Safety Closed IV Catheter System, or other integrated catheter systems.

Referring now to FIG. 2A-3C, the device 40 may include one or more ofthe following: a body 42, a spring 44, and a housing 46. In someembodiments, the housing 46 may include an inner portion 46 a, which maybe coupled to an outer portion 46 b. The outer portion is removed inFIGS. 1-2C for illustration purposes, but is illustrated in FIGS. 3A-3C,according to some embodiments. In some embodiments, the body 42 mayinclude a distal end 48, a proximal end 50, and a lumen 52 extendingthrough the distal end 48 and the proximal end 50. In some embodiments,the proximal end 50 of the body 42 may include a connector 54. In someembodiments, the connector 54 may include a male or female Luerconnector with a Luer-slip or Luer-Lock feature configured to couple theconnector 54 to a medical device, such as, for example, the medicaldevice 102 illustrated in FIGS. 4-7 or another suitable medical device.

In some embodiments, the connector 54 may include any suitableneedleless connector. An example needleless connector may be describedin U.S. Pat. No. 8,066,670, filed Nov. 5, 2007, entitled VASCULAR ACCESSDEVICE SEPTUM VENTING, which is hereby incorporated by reference. Insome embodiments, the needleless connector may include a SMARTSITE™needle-free connector provided by Becton, Dickinson and Company.

In some embodiments, the connector 54 may include a body 55, a septum 56disposed within the body 55, and an internal blunt cannula 58. In someembodiments, the septum 56 may include a split-septum. In someembodiments, the internal blunt cannula 58 may provide an internal fluidpath 60 in fluid communication with the lumen 52 of the body 42. In someembodiments, an access luer of the medical device, such as an infusiondevice, may contact a proximal end 62 of the septum 56 and compress theseptum 56, opening the internal fluid path 60. In some embodiments, whenthe access luer is removed, the septum 56 may return to cover theinternal blunt cannula 58 and close the internal fluid path 60 onceagain. In some embodiments, the proximal end 62 may include a generallyplanar proximal surface 64, which may facilitate swabbing or scrubbingof the proximal end 62. In some embodiments, the septum 56 may include aslit 65.

In some embodiments, at least a portion of the connector 54 and theproximal end 50 may be monolithically formed as a single unit. In someembodiments, the connector 54 may be coupled to the proximal end 50 viaa Luer connector, which may include a Luer-slip feature, a Luer-lockfeature, (as illustrated, for example, in FIG. 3A), or another suitableconnection.

In some embodiments, the distal end 48 of the body 42 may include a luerconnector 66 or another suitable connector, which may be coupled to thecatheter assembly 16. In some embodiments, the luer connector 66 mayinclude a slip or thread male luer connector. In some embodiments, thedistal end 48 of the body 42 may be coupled to the adapter 38, which mayinclude a female luer adapter.

In some embodiments, the housing 46 may be movable with respect to theconnector 54. In some embodiments, when the housing 46 is disposed in aproximal position, the connector 54 may be disposed within the housing46. In some embodiments, in response to movement of the housing 46 fromthe proximal position to a distal position, the connector 54 may bedisposed proximal to the housing 46. In some embodiments, the device 40may not include the spring 44, and the housing 46 may be manuallyreturned to the proximal position and/or moved to the distal position.

In some embodiments, the inner portion 46 a may be coupled to the outerportion 46 b at one or more of the flanges 76. In some embodiments, theinner portion 46 a and the outer portion 46 b may be integrally formedor monolithically formed as a single unit.

In some embodiments, the housing 46 may be coupled to a proximal end 68of the spring 44 and may enclose the connector 54. In some embodiments,the connector 54 may be sealed within the housing 46. In someembodiments, a distal end 70 of the spring 44 may be coupled to the body42. In some embodiments, the housing 46 may include a flap 71, which mayinclude an antimicrobial compound 73. In some embodiments, the housing46 may not include the flap 71.

As an example, one or more of the following: the body 55, the flap 71,and the housing 46, may be constructed of a thermoplastic material thatmay incorporate functional moieties, such as, for example, fluoro orsilicone, which may tend to migrate onto a surface of the thermoplasticmaterial. The functional moieties on the surface of the thermoplasticmaterial may potentially reduce bacteria adhesion by creating ahydrophobic and lubricious environment. As another example, one or moreof the following: the body 55, the housing 46, and the flap 71, mayinclude the antimicrobial compound 73, which may be applied as anantimicrobial coating. As yet another example, the flap 71 may include apad or cloth, which may include the antimicrobial compound 73.

In one particular embodiment, the antimicrobial agent used as theantimicrobial compound 73 included in the pad or the cloth of the flap71 or in the antimicrobial coating may include chlorhexidine includingchlorhexidine diacetate (CHA) and chlorhexidine gluconate (CHG).However, any other antimicrobial agent as widely reported in literaturecould also be used. Non-limiting examples of the antimicrobial coatingand related application methods may be described in: U.S. Pat. No.8,691,887, filed Jun. 2, 2009, entitled “ANTIMICROBIAL COATINGCOMPOSITIONS”; U.S. Pat. No. 8,754,020, filed Apr. 22, 2013, entitled“ANTIMICROBIAL LUBRICANT COMPOSITIONS”; U.S. Pat. No. 4,713,402, filedAug. 30, 1985, entitled “PROCESS FOR PREPARINGANTITHROMBOGENIC/ANTIBIOTIC POLYMERIC PLASTIC MATERIALS” U.S. Pat. No.4,442,133, filed Feb. 22, 1982, entitled “ANTIBIOTIC BONDING OF VASCULARPROSTHESES AND OTHER IMPLANTS”; U.S. Pat. No. 4,678,660, filed Aug. 14,1985, entitled “THERMOPLASTIC POLYURETHANE ANTICOAGULANT ALLOY COATING;”U.S. Pat. No. 5,013,306, filed Mar. 21, 1990, entitled “ANTI-INFECTIVEAND ANTITHROMBOGENIC MEDICAL ARTICLES AND METHOD FOR THEIR PREPARATION”;U.S. Pat. No. 6,261,271, filed Jan. 13, 1998, entitled “ANTI-INFECTIVEAND ANTITHROMBOGENIC MEDICAL ARTICLES AND METHOD FOR THEIR PREPARATION”;and U.S. Pat. No. 5,322,659, filed Sep. 21, 1990, entitled “METHOD FORRENDERING A SUBSTRATE SURFACE ANTITHROMBOGENIC AND/OR ANTI-INFECTIVE,”each of which is incorporated herein by reference.

In some embodiments, when the housing 46 is disposed in the proximalposition, as illustrated, for example, in FIGS. 2A and 3A, the flap 71may cover the connector 54, the antimicrobial compound 73 may contactthe connector 54, and the spring 44 may be uncompressed. In someembodiments, the flap 71 may automatically swab the connector 54 inresponse to the flap 71 moving from a closed position, illustrated, forexample, in FIG. 2A, to an open position, illustrated, for example, inFIG. 2B or FIG. 2C. In some embodiments, the antimicrobial compound 73may be transferred from the flap 71 to the septum 56 in response to theflap 71 contacting and/or swabbing the septum 56.

In some embodiments, in response to movement of the housing 46 from theproximal position to the distal position, the spring 44 may becompressed and the flap 71 may open. In some embodiments, the distalposition may include a first distal position, illustrated, for example,in FIGS. 2B and 3B or a second distal position, illustrated, forexample, in FIGS. 2C and 3C.

In some embodiments, the device 40 may include a support structure 72,which may include one or more elongated guides 74. In some embodiments,the housing 46 may include one or more flanges 76. In some embodiments,in response to movement of the housing 46 from the proximal position tothe distal position, the flanges 76 may be configured to move along theelongated guides 74 in a distal direction.

In some embodiments, the elongated guides 74 may include one or morestops 78. In some embodiments, the flanges 76 may be configured to movealong the elongated guides 74 in the distal direction when the flanges76 are proximal to and spaced apart from the stops 78. In someembodiments, in response to movement of the housing 46 in the distaldirection and the flanges 76 contacting the stops 78, as illustrated,for example, in FIG. 2B, the housing 46 and the support structure 72 maybe configured to move together in the distal direction. For example, inresponse to movement of the housing 46 in the distal direction and theflanges 76 contacting the stops 78, the housing 46 and the supportstructure 72 may be configured to move together in the distal directionfrom the position illustrated in FIG. 2B to the position in FIG. 2C. Insome embodiments, the flanges 76 may facilitate holding or gripping ofthe housing 46 by the clinician.

In some embodiments, a proximal end 80 of the support structure 72 mayinclude an opening 82. In some embodiments, a diameter of the opening 82may be less than a diameter of the flap 71, which may prevent the flap71 from opening and/or fully opening when the housing 46 is disposed inthe proximal position.

In some embodiments, as illustrated in FIGS. 2C and 3C, the connector 54may be exposed for coupling to the access luer of the medical device. Insome embodiments, threading 84 may be exposed, as illustrated in FIGS.2C and 3C. In response to coupling of the access luer of the medicaldevice to the connector 54, the flap 71 may be maintained in a fullyopen position, as illustrated, for example, in FIGS. 2C and 3C. In someembodiments, in response to the clinician releasing his or her hold onthe housing 46 and/or the support structure 72, the spring 44 may returnthe housing 46 and/or the support structure 72 to the proximal position.

Referring now to FIGS. 4A-4E, in some embodiments, a housing 86 todisinfect a connector 88 may include a body 90, which may include adistal end 92, a proximal end 94, and a lumen 96 extending through thedistal end 92 and the proximal end 94. In some embodiments, the distalend 92 may be configured to receive the connector 88. In someembodiments, the connector 88 may include or correspond to the connector54 discussed with respect to FIGS. 2A-3C. In some embodiments, theproximal end 94 may include an access opening 98 configured to receivethe medical device 102, such as an infusion device or syringe. In someembodiments, the housing 86 may be used with the catheter system 14 ofFIG. 1 or any other suitable catheter system.

In some embodiments, the housing 86 may include a cover 100 coupled tothe proximal end 94 of the body 90 and covering the access opening 98.In some embodiments, the cover 100 may include the antimicrobialcompound 73. In some embodiments, in response to removal of the medicaldevice 102 from the access opening 98, the cover 100 may be configuredto automatically close, and the antimicrobial compound 73 may beconfigured to contact a proximal end of the connector 88. In someembodiments, the cover 100 may be spring-loaded, which may facilitateclosing of the cover 100 in response to removal of the medical device102 from the access opening 98. In some embodiments, the cover 100 mayinclude a torsion spring. In some embodiments, the connector 88 may beenclosed or sealed within the housing 86 when the cover 100 is closed.

In some embodiments, the cover 100 may swab the connector 88 in responseto the cover 100 moving from a closed position, illustrated, forexample, in FIG. 4B, to an open position, illustrated, for example, inFIG. 4C. In some embodiments, the cover 100 may swab the connector 88 inresponse to the cover 100 moving from the open position to the closedposition. In some embodiments, when the cover 100 is in the openposition, the medical device 102 may be connected to the connector 88.In some embodiments, the automatic closing of the cover 100 and swabbingof the connector 88 in response to removal of the medical device 102from the access opening 98 may protect the connector 88 fromcontamination by bacteria.

In some embodiments, the cover 100 may be coupled to the proximal end 94at a pivot 104. In some embodiments, the cover 100 may be configured topivot about the pivot 104 between the open position and the closedposition. In some embodiments, the cover 100 may be configured to pivotabout the pivot 104 on an axis generally parallel to a central axis 106of the body 90. In some embodiments, the pivot 104 may include a pin oranother suitable pivoting mechanism. In some embodiments, in response toopening of the cover 100, a new cleaning pad may be exposed and an oldcleaning pad may be removed.

Referring now to FIGS. 5A-5E, in some embodiments, a housing 108 todisinfect the connector 88 may include a body 110, which may include adistal end 112, a proximal end 114, and a lumen 116 extending throughthe distal end 112 and the proximal end 114. In some embodiments, thedistal end 112 may be configured to receive the connector 88. In someembodiments, the proximal end 114 may include an access opening 118configured to receive the medical device 102, such as an infusion deviceor syringe. In some embodiments, the access opening 118 may be spacedapart from a proximal end 119 of the connector 88 such that the medicaldevice 102 and the connector 88 may be directly coupled together. Insome embodiments, the housing 108 may include or correspond to thehousing 86 described with respect to FIGS. 4A-4E.

In some embodiments, the housing 108 may include a cover 120 coupled tothe body 110 and covering the access opening 118. In some embodiments,the cover 120 may include the antimicrobial compound 73. In someembodiments, in response to removal of the medical device 102 from theaccess opening 118, the cover 120 may be configured to automaticallyclose, and the antimicrobial compound 73 may be configured to contactthe proximal end 119 of the connector 88. In some embodiments, the cover120 may be spring-loaded, which may facilitate closing of the cover 120in response to removal of the medical device 102 from the access opening118. In some embodiments, the cover 120 may include a torsion spring. Insome embodiments, the connector 88 may be enclosed or sealed within thehousing 108 when the cover 120 is closed.

In some embodiments, the cover 120 may swab the connector 88 in responseto the cover 120 moving from a closed position, illustrated, forexample, in FIG. 5B, to an open position, illustrated, for example, inFIG. 5C. In some embodiments, the cover 120 may swab the connector 88 inresponse to the cover 120 moving from the open position to the closedposition. In some embodiments, when the cover 120 is in the openposition, the medical device 102 may be coupled to the connector 88. Insome embodiments, the automatic closing of the cover 120 and swabbing ofthe connector 88 in response to removal of the medical device 102 fromthe access opening 118 may protect the connector 88 from contaminationby bacteria.

In some embodiments, the cover 120 may be coupled to the body 110 at oneor more pivots 122. In some embodiments, the cover 120 may be configuredto pivot about the pivots 122 between the open position and the closedposition. In some embodiments, the cover 120 may be configured to pivotabout the pivots 122 between the open position and the closed positionon an axis generally perpendicular to a central axis 124 of the body110. In some embodiments, the pivots 122 may each include a pin oranother suitable pivoting mechanism.

In some embodiments, a first distal arm 128 a and a second distal arm128 b (which may be referred to collectively in the present disclosureas “distal arms 128”) may extend from a first pivot 122 a and a secondpivot 122 b (which may be referred to collectively in the presentdisclosure as “pivots 122”), respectively. In some embodiments, a firstproximal arm 130 a and a second proximal arm 130 b (which may bereferred to collectively in the present disclosure as “proximal arms130”) may be joined to the cover 120, which may be configured to contactthe proximal end of the connector 88 when the cover 120 is in the closedposition. In some embodiments, a semi-circular portion 132 may bedisposed between the distal arms 128 and the proximal arms 130. In someembodiments, the semi-circular portion 132 may be configured to fitaround the body 110 when the cover is in the open position such that thesemi-circular portion and the body 110 contact each other and are notspaced apart.

Referring now to FIGS. 6A-6D, in some embodiments, a housing 134 todisinfect the connector 88 may include a body 136, which may include adistal end 138, a proximal end 140, and a lumen 142 extending throughthe distal end 138 and the proximal end 140. In some embodiments, thedistal end 138 may be configured to receive the connector 88. In someembodiments, the proximal end 140 may include an access opening 144configured to receive the medical device 102, such as an infusion deviceor syringe. In some embodiments, the access opening 144 may be spacedapart from a proximal end 119 of the connector 88 such that the medicaldevice 102 and the connector 88 may be directly coupled together. Insome embodiments, the housing 134 may include or correspond to thehousing 86 described with respect to FIGS. 4A-4E and/or the housing 108described with respect to FIG. 5A-5E.

In some embodiments, the housing 134 may include a cover 120 coupled tothe body 136 and covering the access opening 144. In some embodiments,the cover 120 may include the antimicrobial compound 73. In someembodiments, in response to removal of the medical device 102 from theaccess opening 144, the cover 120 may be configured to automaticallyclose, and the antimicrobial compound 73 may be configured to contactthe proximal end 119 of the connector 88. In some embodiments, anantimicrobial strip (such as, for example, the antimicrobial strip 170illustrated in FIGS. 7A-7D) may be disposed over the access opening 144.In some embodiments, the cover 120 may be spring-loaded, which mayfacilitate closing of the cover 120 in response to removal of themedical device 102 from the access opening 144. In some embodiments, theconnector 88 may be enclosed or sealed within the housing 134 when thecover 120 is closed.

In some embodiments, the cover 120 may swab the connector 88 in responseto the cover 120 moving from a closed position, illustrated, forexample, in FIG. 6B, to an open position, illustrated, for example, inFIG. 6C. In some embodiments, the cover 120 may swab the connector 88 inresponse to the cover 120 moving from the open position to the closedposition. In some embodiments, when the cover 120 is in the openposition, the medical device 102 may be coupled to the connector 88. Insome embodiments, the automatic closing of the cover 120 and swabbing ofthe connector 88 in response to removal of the medical device 102 fromthe access opening 144 may protect the connector 88 from contaminationby bacteria.

In some embodiments, the cover 120 may be coupled to the body 136 at oneor more pivots 148. In some embodiments, the cover 120 may be configuredto pivot about the pivots 148 between the open position and the closedposition. In some embodiments, the cover 120 may be configured to pivotabout the pivots 148 between the open position and the closed positionon an axis generally perpendicular to a central axis 149 of the body136. In some embodiments, the pivots 148 may each include a pin oranother suitable pivoting mechanism.

In some embodiments, the cover 120 may include a distal tab 150 and anL-shaped portion 152 coupled to the distal tab 150. In some embodiments,the pivots 148 may be disposed between the distal tab 150 and theL-shaped portion 152. In some embodiments, in response to depression ofthe distal tab 150, the L-shaped portion 152 may be raised and theaccess opening 144 may be exposed.

Referring now to FIGS. 7A-7D, in some embodiments, a housing 154 todisinfect the connector 88 may include a body 156, which may include adistal end 158, a proximal end 160, and a lumen 162 extending throughthe distal end 158 and the proximal end 160. In some embodiments, thehousing 154 may include or correspond to one or more of the following:the housing 86 described with respect to FIGS. 4A-4E, the housing 108described with respect to FIG. 5A-5E, and the housing 134 described withrespect to FIGS. 6A-6D.

In some embodiments, the body 156 may include a distal piece 166 and aproximal piece 168, which may rotate with respect to the distal piece166. In some embodiments, an antimicrobial strip 170 may be disposedover the access opening 164. In some embodiments, in response torotation of the proximal piece 168 with respect to the distal piece 166,the antimicrobial strip 170 may advance and travel across the accessopening 164 in a conveyor belt-like fashion. In some embodiments, theproximal piece 168 may be rotated in a first direction with respect tothe distal piece 166, automatically pulling the antimicrobial strip 170across the proximal end 119 of the connector 88 prior to use of theconnector 88. In some embodiments, an aperture 172 in the antimicrobialstrip 170 may allow the medical device 102 to access and couple to theconnector 88.

In some embodiments, following uncoupling of the medical device 102 fromthe connector 88 and removal of the medical device 102 from the body156, the proximal piece 168 may be rotated in the first direction topull the antimicrobial strip 170 across the proximal end 119 and swabthe proximal end 119 of the connector 88. In some embodiments, theantimicrobial strip 170 may include the antimicrobial compound 73. Insome embodiments, a color change in the antimicrobial strip 170 mayindicate the antimicrobial strip 170 is exhausted and the housing 154may be replaced.

In some embodiments, rotating the distal piece 166 and/or the proximalpiece 168 may turn a set of gears that translate the rotating motioninto movement of the antimicrobial strip 170 across the aperture 172,allowing a fresh portion of the antimicrobial strip 170 to be exposed.In some embodiments, the set of gears may be part of a differentialmechanism, which may include a crown wheel, pinion, sun gear, planetarygears, differential shaft, etc. as are understood in the art. In someembodiments, in response to the distal piece 166 and/or the proximalpiece 168 being rotated in a first direction, the antimicrobial strip170 may move across the aperture 172.

Referring now to FIGS. 8A-8G, in some embodiments, a device 174 todisinfect the connector 88 may include an inner housing 176, which maybe annular, and an outer housing 178, which may be annular. In someembodiments, the inner housing 176 may include a proximal opening 179and may be configured to receive the connector 88. In some embodiments,the connector 88 may be disposed in a snap fit with the inner housing176. In some embodiments, the outer housing 178 may be moveable withrespect to the inner housing 176 between a proximal position,illustrated, for example, in FIGS. 8A and 8C, and a distal position,illustrated, for example, in FIG. 8B. In some embodiments, the outerhousing 178 may include a set of teeth 180.

In some embodiments, the device 174 may include a rachet wheel 182,which may include an inner set of teeth 184 and an outer set of teeth186. In some embodiments, a first mandrel 188 may extend through therachet wheel 182 and may include a pawl 190. In some embodiments, asecond mandrel 192 may be disposed on an opposite side of the innerhousing 176 as the first mandrel 188.

In some embodiments, an antimicrobial strip 194 may be wrapped aroundthe second mandrel 192 and coupled to the first mandrel 188. In someembodiments, the antimicrobial strip 194 may extend over the proximalopening 179 of the inner housing 176. In some embodiments, in responseto movement of the outer housing 178 between the proximal position andthe distal position, the pawl 190 may catch against the inner set ofteeth 184, the set of teeth 180 of the inner surface may successivelyengage the outer set of teeth 186, and the rachet wheel 182 and thefirst mandrel 188 may rotate such that the antimicrobial strip 194 movesacross the proximal opening 179 of the inner housing 176. In someembodiments, the antimicrobial strip 194 may include cloth, tape, oranother suitable material. In some embodiments, the antimicrobial strip194 may include the antimicrobial compound 73.

In some embodiments, in response to movement of the outer housing 178between the proximal position and the distal position, the antimicrobialstrip 194 may wrapped around the first mandrel 188 and/or unwrapped fromthe second mandrel 192. In some embodiments, the antimicrobial strip 194may include multiple holes 196 configured to allow the medical device102 to extend through and couple to the connector 88 for infusion orblood withdrawal. In some embodiments, a distal end of the connector 88may be coupled to extension tubing 34 or the adapter 38.

In some embodiments, the outer housing 178 may include a flap 198. Insome embodiments, in response to movement of the outer housing 178between the proximal position and the distal position, the flap 198 maybe opened. In some embodiments, the outer housing 178 may be configuredto enclose the connector 88.

In some embodiments, the device 174 may include another rachet wheel200, which may also include the inner set of teeth 184 and the outer setof teeth 186. In some embodiments, the first mandrel 188 may extendthrough the other rachet wheel 200. In some embodiments, theantimicrobial strip 194 may be disposed between the rachet wheel 182 andthe other rachet wheel 200. In some embodiments, the device 174 mayinclude an arm 202 extending through the first mandrel 188. In someembodiments, the first mandrel 188 may be configured to rotate withrespect to the arm 202. In some embodiments, the arm 202 may be coupledto the inner housing 176.

Referring now to FIG. 9A, the device 40 is illustrated in a retractedposition, according to some embodiments. In some embodiments, when thedevice 40 is in the retracted position, the housing 46 may be in theproximal position. In some embodiments, the housing 46 and the body 42may be configured to slide axially towards each other to move the device40 from the retracted position in which the connector 54 is enclosed inthe housing 46 to a projected position in which the connector 54 isexposed proximal to the housing. For example, the housing 46 may slideaxially in a distal direction from the retracted position and/or thebody 42 may slide axially in a proximal direction from the retractedposition. In some embodiments, the housing 46 may slide axially in thedistal direction to open the flap 71, and after the flap 71 is open, theconnector 54 may move proximally and outside the housing 46. In someembodiments, when the device 40 is in the projected position, thehousing 46 may be disposed in the distal position.

In some embodiments, the device 40 may include a spring 210, which mayinclude a proximal end and a distal end. In some embodiments, theproximal end of the spring 210 may be coupled to the body 42. In someembodiments, the distal end of the spring 210 may urge a cam body 212 ofthe device 40 distally. In some embodiments, an inner surface of theouter portion 46 b may include one or more rails 214. In someembodiments, an outer surface of the cam body 212 may include one ormore slots 216, which may extend completely or partially through the cambody 212. In some embodiments, when the device 40 is in the retractedposition, as illustrated, in FIG. 9A, the rails 214 may be disposedwithin the slots 216, which may prevent rotation of the cam body 212.

Referring now to FIG. 9B, in some embodiments, as the device 40 movesfrom the retracted position to the projected position, the body 42 mayslide axially in the proximal direction and/or the housing 46 may slideaxially in the distal direction. In these embodiments, the rails 214 mayslide within the slots 216. In some embodiments, as the housing 46slides axially in the distal direction, the flanges 76 may move alongthe elongated guides 74 or the flanges 76 and the support structure 72may move together in the distal direction.

Referring now to FIG. 9C-9E, the device 40 is illustrated in theprojected position, according to some embodiments. In some embodiments,in response to the housing 46 and the body 42 sliding axially towardseach other, the rails 214 may be removed from the slots 216, which mayallow the cam body 212 to rotate. In some embodiments, one or moreangled surfaces of the cam body 212 and/or one or more teeth 218 coupledto the body 42 may cause the cam body 212, which may be urged distallyby the spring 210, to rotate. In some embodiments, the cam body 212 mayrotate until the rails 214 contact a stop surface 220 of the cam body212, as illustrated, for example, in FIG. 9C.

In some embodiments, the device 40 may be locked in the projectedposition. In some embodiments, the rails 214 and/or the teeth 218 maycontact the cam body 212 when the device 40 is in the projectedposition, which may lock the device 40 in the projected position. Insome embodiments, in response movement of the body 42 proximally beyondthe projected position, the device 40 may be configured to unlock andreturn to the retracted position. For example, the rails 214 may nolonger contact the stop surface 220 and the cam body 212 may rotate suchthat the rails 214 can slide through the slots 216.

Referring now to FIG. 9F, in some embodiments, when the device 40 is inthe retracted position, the flap 71 may cover the connector 54 and/orthe antimicrobial compound 73 may contact the connector 54. In someembodiments, the flap 71 may automatically swab the connector 54 inresponse to the flap 71 moving from a closed position, illustrated, forexample, in FIG. 9F, to an open position, illustrated, for example, inFIGS. 9C-9E. In some embodiments, the antimicrobial compound 73 may betransferred from the flap 71 to the septum 56 in response to the flap 71contacting and/or swabbing the septum 56.

Referring now to FIGS. 10A-10G, a sequence of positions of the device 40is illustrated in order from 10A-10G, according to some embodiments. Asillustrated in FIG. 10A, in some embodiments, in response to the housing46 and the body 42 sliding axially towards each other to a firstposition, the rails 214 may partially be removed from the slots 216.

As illustrated in FIG. 10B, in some embodiments, in response to thehousing 46 and the body 42 sliding axially towards each other to asecond position, the rails 214 may be removed from the slots 216, whichmay allow the cam body 212 to rotate. In some embodiments, the angledsurfaces 222 of the cam body 212 and/or one or more teeth 218 coupled tothe body 42 may cause the cam body 212, which may be urged distally bythe spring 210, to rotate.

As illustrated in FIG. 10C, in some embodiments, the cam body 212 mayrotate until the rails 214 contact the stop surface 220 of the cam body212. In some embodiments, the rails 214 and/or the teeth 218 may contactthe cam body 212 when the device 40 is in the projected position, whichmay lock the device 40 in the projected position.

As illustrated in FIGS. 10D-10E, in some embodiments, in responsemovement of the body 42 proximally beyond the projected position or theconnector 54 moving further from the housing 46 than in the projectedposition, the device 40 may be configured to unlock and return to theretracted position. For example, the rails 214 may no longer contact thestop surface 220 and the cam body 212 may rotate such that the rails 214can slide through the slots 216, as illustrated, for example, in FIGS.10F-10G.

FIGS. 9-10 illustrate an example mechanism for moving the device 40 fromthe retracted position to the projected position and back to theretracted position, according to some embodiments. It is understood thatvariations of the mechanism or other mechanisms may be used. Allexamples and conditional language recited herein are intended forpedagogical objects to aid the reader in understanding the invention andthe concepts contributed by the inventor to furthering the art, and areto be construed as being without limitation to such specifically recitedexamples and conditions. Although embodiments of the present inventionshave been described in detail, it should be understood that the variouschanges, substitutions, and alterations could be made hereto withoutdeparting from the spirit and scope of the invention.

1. A device to couple a vascular access device to a medical device, thedevice comprising: a housing; and a body partially disposed within thehousing, wherein the body comprises a distal end, a proximal end, and alumen extending through the distal end and the proximal end, wherein theproximal end comprises a connector, wherein the housing and the body areconfigured to slide axially towards each other to move the device from aretracted position in which the connector is enclosed within the housingto a projected position in which the connector is exposed proximal tothe housing.
 2. The device of claim 1, wherein the housing comprises aflap, wherein when the device is in the retracted position, the flapcovers the connector, wherein in response to the housing moving distallyfrom the retracted position, the flap opens.
 3. The device of claim 1,further comprising a spring, wherein the spring comprises a distal endand a proximal end, wherein the distal end of the spring is coupled tothe body, wherein the proximal end of the spring urges the housingproximally.
 4. The device of claim 1, wherein the flap comprises anantimicrobial compound, wherein when the device is in the retractedposition, the antimicrobial compound contacts the connector.
 5. Thedevice of claim 1, wherein the distal end of the body comprises a luerconnector.
 6. The device of claim 1, further comprising a supportstructure comprising an elongated guide, wherein the housing comprises aflange, wherein in response to movement of the housing from distallyfrom the retracted position, the flange is configured to move along theelongated guide in a distal direction.
 7. The device of claim 6, whereinthe elongated guide comprises a stop, wherein the flange is configuredto move along the guide in the distal direction when the flange isproximal to and spaced apart from the stop, wherein in response tomovement of the housing in the distal direction from the retractedposition and the flange contacting the stop, the housing and the supportstructure are configured to move together in the distal direction. 8.The device of claim 1, wherein the device is configured to lock in theprojected position.
 9. The device of claim 8, wherein in responsemovement of the body proximally beyond the projected position, thedevice is configured to unlock and return to the retracted position. 10.A housing to disinfect a vascular access device connector, comprising: abody, comprising a distal end, a proximal end, and a lumen extendingthrough the distal end and the proximal end, wherein the distal end isconfigured to receive a vascular access device connector, wherein theproximal end comprises an access opening configured to receive aninfusion device; and a cover coupled to the body and covering the accessopening, wherein the cover comprises an antimicrobial compound, whereinin response to removal of the infusion device from the access opening,the cover is configured to automatically close and the antimicrobialcompound is configured to automatically contact and scrub a proximal endof the vascular access device connector.
 11. The housing of claim 10,wherein the cover is spring-loaded.
 12. The housing of claim 10, whereinthe cover is coupled to the body at a pivot, wherein the cover isconfigured to pivot about the pivot between an open position and aclosed position, wherein the cover is configured to pivot about thepivot on an axis generally perpendicular to a central axis of the body.13. The housing of claim 10, wherein the cover is coupled to the body ata pivot, wherein the cover is configured to pivot about the pivotbetween an open position and a closed position, wherein the cover isconfigured to pivot about the pivot on an axis generally parallel to acentral axis of the body.
 14. The housing of claim 13, wherein a movableportion of the body comprises a distal end, wherein the distal endcomprises a first arm that extends from the pivot and a second arm thatextends from another pivot aligned with the pivot.
 15. The housing ofclaim 14, wherein the movable portion of the body comprises a proximalend and a semi-circular portion disposed between the distal end and theproximal end, wherein the distal end comprises the first arm and thesecond arm, wherein the proximal end comprises a contact portionconfigured to contact the proximal end of the vascular access deviceconnector when the cover is in the closed position, wherein thesemi-circular portion is configured to fit around the body when thecover is in the open position.
 16. The housing of claim 13, wherein thecover comprises a distal tab and an L-shaped portion coupled to thedistal tab, wherein in response to depression of the distal tab, theL-shaped portion is raised and the access opening is exposed.
 17. Adevice to disinfect a vascular access device connector, comprising: aninner housing, comprising a proximal opening and configured to receive avascular access device connector; an outer housing moveable with respectto the inner housing between a proximal position and a distal position,wherein the outer housing comprises a set of teeth; a rachet wheelcomprising an inner set of teeth and an outer set of teeth; and a firstmandrel extending through the rachet wheel and comprising a pawl; asecond mandrel disposed on an opposite side of the inner housing as thefirst mandrel; antimicrobial strip wrapped around the second mandrel andcoupled to the first mandrel, wherein the antimicrobial strip extendsover the proximal opening of the inner housing; wherein in response tomovement of the outer housing between the proximal position and thedistal position, the pawl catches against the inner set of teeth, theset of teeth of the inner surface successively engage the outer set ofteeth, and the rachet wheel and the mandrel rotate such that theantimicrobial strip moves across the proximal opening of the innerhousing.
 18. The device of claim 17, wherein in response to movement ofthe outer housing between the proximal position and the distal position,the antimicrobial strip is wrapped around the first mandrel andunwrapped from the second mandrel.
 19. The device of claim 17, whereinthe outer housing comprises a flap, wherein in response to movement ofthe outer housing between the proximal position and the distal position,the flap is opened.
 20. The device of claim 17, wherein theantimicrobial strip comprises a plurality of holes configured to allow amedical device to couple to the vascular access device connector forinfusion or blood withdrawal.
 21. The device of claim 17, wherein theouter housing is configured to enclose the vascular access deviceconnector.
 22. The device of claim 17, further comprising another rachetwheel, wherein the first mandrel extends through the other rachet wheel,wherein the antimicrobial strip is disposed between the rachet wheel andthe other rachet wheel.
 23. The device of claim 17, further comprisingan arm extending through the mandrel, wherein the mandrel is configuredto rotate with respect to the arm, wherein the arm is coupled to theinner housing.